Dopamine Hydrochloride

Dopamine HCl is indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarction, trauma, endotoxic septicemia, open-heart surgery, renal failure, and chronic cardiac decompensation as in congestive failure.

Patients most likely to respond adequately to dodpamine HCl are those in whom physiological parameters, such as urine flow, myocardial function, and blood pressure, have not undergone profound deterioration. Multiclinic trials indicate that the shorter the time interval between onset of signs and symptoms and initiation of therapy with volume correction and dopamine HCl, the better the prognosis. Where appropriate, blood volume restoration with a suitable plasma expander or whole blood should be accomplished or completed prior to administration of dopamine HCl.

Poor Perfusion Of Vital Organs

Urine flow appears to be one of the better diagnostic signs by which adequacy of vital organ perfusion can be monitored. Nevertheless, the physician should also observe the patient for signs of reversal of confusion or reversal of comatose condition. Loss of pallor, increase in toe temperature, and/or adequacy of nail bed capillary filling may also be used as indices of adequate dosage. Clinical studies have shown that when dopamine HCl is administered before urine flow has diminished to levels approximating 0.3 mL/minute, prognosis is more favorable. Nevertheless, in a number of oliguric or anuric patients, administration of dopamine HCl has resulted in an increase in urine flow which in some cases reached normal levels. Dopamine HCl may also increase urine flow in patients whose output is within normal limits and thus may be of value in reducing the degree of pre-existing fluid accumulation. It should be noted that at doses above those optimal for the individual patient, urine flow may decrease, necessitating reduction of dosage.

Low Cardiac Output

Increased cardiac output is related to dopamine's direct inotropic effect on the myocardium. Increased cardiac output at low or moderate doses appears to be related to a favorable prognosis. Increase in cardiac output has been associated with either static or decreased systemic vascular resistance (SVR). Static or decreased SVR associated with low or moderate movements in cardiac output is believed to be a reflection of differential effects on specific vascular beds with increased resistance in peripheral beds (e.g., femoral) and concomitant decreases in mesenteric and renal vascular beds.

Redistribution of blood flow parallels these changes so that an increase in cardiac output is accompanied by an increase in mesenteric and renal blood flow. In many instances the renal fraction of the total cardiac output has been found to increase. Increase in cardiac output produced by dopamine is not associated with substantial decreases in systemic vascular resistance as may occur with isoproterenol.

Hypotension

Hypotension due to inadequate cardiac output can be managed by administration of low to moderate doses of dopamine HCl, which have little effect on SVR. At high therapeutic doses, the alphaadrenergic activity of dopamine becomes more prominent and thus may correct hypotension due to diminished SVR. As in the case of other circulatory decompensation states, prognosis is better in patients whose blood pressure and urine flow have not undergone profound deterioration. Therefore, it is suggested that the physician administer dopamine HCl as soon as a definite trend toward decreased systolic and diastolic pressure becomes evident.

In case of accidental overdosage, as evidenced by excessive elevation of blood pressure, reduce rate of administration or temporarily discontinue dopamine HCl until patient's condition stabilizes. Since dopamine's duration of action is quite short, no additional remedial measures are usually necessary. If these measures fail to stabilize the patient’s condition, use of the short-acting alpha-adrenergic blocking agent phentolamine should be considered.

Administration

Administer by IV infusion.115 116

Also has been administered by intraosseous infusion† during ACLS.401 403

IV Infusion

For solution and drug compatibility information, see Compatibility under Stability.

Infuse IV into a large vein, preferably the antecubital vein, using an infusion pump or other apparatus to control the rate of flow and avoid inadvertent administration of a bolus dose.115 116

Use less suitable veins (e.g., hand or ankle vein) only when required, but switch to a preferred vein as soon as possible.115

Continuously monitor infusion site for free flow.115

Avoid extravasation.115 116 (See Boxed Warning and also see Extravasation under Cautions.)

A controlled-infusion device, preferably a volumetric pump, should be used; do not administer via an ordinary, gravity-controlled IV administration set.115 116

Dopamine in 5% dextrose in flexible containers (e.g., LifeCare) should not be used in series connections.116

Consult manufacturer's labeling for proper methods of administration and other associated precautions.115 116

Must dilute the commercially available injection concentrate for IV infusion prior to administration;115 alternatively, may use commercially available prediluted solutions of dopamine hydrochloride in 5% dextrose.116

Individualize concentration according to patient dosage and fluid requirements.b Consult manufacturer's prescribing information for suggested dilutions.115

Avoid bolus administration.115

Rate of IV infusion varies according to individual dose requirements.115 116 (See Dosage under Dosage and Administration.)

Dosage

Individualize and carefully adjust dosage to achieve the desired hemodynamic and renal response as indicated by heart rate, BP, urine flow, and, whenever possible, measurement of central venous or pulmonary wedge pressure and cardiac output.115 116 Once optimal hemodynamic effects have been achieved, use lowest possible dosage to maintain these effects.b

When discontinuing therapy, it may be necessary to gradually decrease the dose while expanding blood volume with IV fluids to prevent a recurrence of hypotension.115 Sudden discontinuance can precipitate marked hypotension.b (See Hypotension under Cautions.) In patients who have been receiving moderate to high doses, some clinicians recommend that the final dosage should not be less than 5 mcg/kg per minute in order to avoid hypotension.b

Pediatric Patients

Studies have not been conducted to specifically inform dosage recommendations in pediatric patients; however, clinical experience indicates that dosing in pediatric patients is generally similar to that in adults.115 116

Usual infusion rate for postresuscitation stabilization is 2–20 mcg/kg per minute.403 Although dosages >5 mcg/kg per minute stimulate the cardiac β-adrenergic receptors, this effect may be reduced in infants.403 Infusion rates >20 mcg/kg per minute may result in excessive vasoconstriction.403

Adults

Usually, initiate at a rate of 2–5 mcg/kg per minute;115 may increase by 1–4 mcg/kg per minute at 10- to 30-minute intervals until the optimal response is attained.b In more severely ill patients, initiate at 5 mcg/kg per minute, and gradually increase in increments of 5–10 mcg/kg per minute up to 20–50 mcg/kg per minute as needed.115

In patients with occlusive vascular disease, some experts recommend initial rate of ≤1 mcg/kg per minute because of risk of local ischemia (e.g., gangrene).59 Monitor closely for any signs or symptoms of compromised circulation; if this occurs, decrease rate or discontinue infusion.115

If MAO inhibitors were used within the previous 2–3 weeks, initiate dopamine at no greater than 10% of the usual dose.115 (See MAO Inhibitors under Cautions.)

Titrate dosage to achieve desired hemodynamic effects.115 Most patients can be maintained at <20 mcg/kg per minute; however, infusion rates >50 mcg/kg per minute have been used safely in advanced states of circulatory decompensation.115

Usual initial dosage range for symptomatic bradycardia is 2–10 mcg/kg per minute; titrate according to patient response.401 Infusion rates >10 mcg/kg per minute are associated with vasoconstrictive effects.401

For postresuscitation stabilization, dosage of 5–10 mcg/kg per minute has been recommended.404

Some clinicians recommend initial rate of 0.5–2 mcg/kg per minute in patients with severe, refractory heart failure.b Usual dosage range is 5–10 mcg/kg per minute.165

To minimize risk of adverse effects, use lowest possible dosage and evaluate patient regularly for the need for continued inotropic therapy.165

Special Populations

Hepatic Impairment

No specific dosage recommendations.115

Renal Impairment

No specific dosage recommendations.115

Geriatric Patients

Initial dosage usually should be at the low end of the range.116

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name